Page 11 - QSC EE Guide 01-20 Remote

Cigna | HSA PPO Plan Cigna | PPO Plan
With the HSA PPO plan, you can pay for qualified Similar to the HSA PPO plan, the PPO plan allows you to
healthcare expenses now and grow your savings direct your own care using the same network as the HSA
for future healthcare needs. This plan combines a PPO plan. If you receive care from a physician who is a
High Deductible Health Plan (HDHP) with a special, member of the network, a greater percentage of the entire
tax-qualified Health Savings Account (HSA). The cost will be paid by the insurance plan. However, you are
money in your account is yours to pay for current not limited to the physicians within the network and you
healthcare expenses - or you can save for future may self-refer to specialists. If you obtain services using a
healthcare expenses. non-network provider, please note that you will be
responsible for the difference between the covered amount
You have the freedom to choose your doctor and the actual charges, and you may be responsible for
without the requirement of selecting a PCP and filing claims.
you may self-refer to specialists. You may use a
network provider whose negotiated rates provide
richer levels of benefits with claim forms filed by
the providers. You may also obtain services using a
non-network provider; however, you will be
responsible for the difference between the covered
amount and the actual charges and you may be
responsible for filing claims.

Once eligible for the plan, QSC will make biweekly
contributions toward your employee/family health
savings account. In addition to the company
contributions, you may elect to make contributions
into your account up to IRS maximums. See page
15 for more information.

Plan Differences HSA PPO
Employee Premiums $ $$$
Health Savings Account ✓
Cost Sharing Contribution, Copay, Contribution, Copay,
Deductible, Deductible,
Coinsurance Coinsurance

Network
- Network Size  
- In-Network Benefits ✓ ✓
- Non-Network Benefits ✓ ✓
Access to Providers Managed by You Managed by You

Finding a Medical Provider
Go to www.cigna.com.
HSA & PPO: Refer to the “Open Access Plus, OA
plus, Choice Fund OA Plus” plan Educational Video
Health Insurance Terms
http://video.burnhambenefits.com/terms